Quality Assurance Coordinator- Transportation Team

City/State

Work Shift

Overview:

Status: Full-time, permanent position (40 hours)

Work hours: 8am to 5pm EST, M-F

Location: This is a remote position in VA with quarterly travel to VA Beach office for priority meetings

Job responsibilities:

• Audit day to day processes SHP PSC staff and transportation provider and working collaboratively with SIU to escalate FWA cases

• Develop the audit tools

• Complete the audits to include JIVA authorizations and CM notes, Listening to NIC live and recorded calls.

• During training they will be expected to take live calls from member, manage the call queue, manage cases to include advising members their trips are either approved or denied!

• With expectation they will cover for PSC and Manager when out of the office.

Education

• Bachelor's degree in Medical, Behavioral Health, or related field (Required)

• QMHP or LMHP (Preferred)

Certification/Licensure

• No specific certification or licensure requirements

Experience

• Minimum 1 year of experience in Healthcare Quality Improvement required

• Experience conducting audits and inspections related to service quality and compliance

• Familiarity with transportation services in a healthcare or support services setting

• Strong communication skills and ability to provide training to external vendors

• Experience in processing and reviewing service authorizations (e.g., mileage, food, lodging)

Sentara Health Plans provides health plan coverage to close to one million members in Virginia. We offer a full suite of commercial products including employee-owned and employer-sponsored plans, as well as Individual & Family Health Plans, Employee Assistance Programs and plans serving Medicare and Medicaid enrollees.

Our quality provider network features a robust provider network, including specialists, primary care physicians and hospitals.

We offer programs to support members with chronic illnesses, customized wellness programs, and integrated clinical and behavioral health services—all to help our members improve their health.

Our success is supported by a family-friendly culture that encourages community involvement and creates unlimited opportunities for development and growth. 

Be a part of an excellent healthcare organization that cares about our People, Quality, Patient Safety, Service, and Integrity. Join a team that has a mission to improve health every day and a vision to be the healthcare choice of the communities that we serve!

To apply, please go to www.sentaracareers.com and use the following as your Keyword Search: JR-88850

Talroo-Health Plan

Keywords: Managed Care, MCO, Healthcare, Health Plan, Remote, Virginia, VA, Transportation, Audit, Quality

Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.

In support of our mission “to improve health every day,” this is a tobacco-free environment.

For positions that are available as remote work, Sentara Health employs associates in the following states:

Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.